{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:26:45Z","timestamp":1789709205908,"version":"4.0.1"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Lateral mass screw (LMS) is a more widely adopted method for posterior cervical spine fixation than the cervical pedicle screw (CPS). Despite its lower pullout strength, the insertions of LMS are more reproducible and have a lower risk. CPS insertion is a technically demanding procedure due to the small pedicle channel. Thus, CPS insertion has a high risk of pedicle wall perforation, resulting in neurovascular injury. For these reasons, surgeons may avoid CPS insertion despite its benefit of greater biomechanical strength. Therefore, an improvement in the CPS design is needed to avoid this catastrophic complication.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To develop a new design of CPS, aiming to decrease pedicle wall perforation, while maintaining the biomechanical properties comparable to those of standard CPS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Materials &amp; methods<\/jats:title>\n<jats:p>To reduce the risk of pedicle wall perforation, a novel CPS design should be configured in tapered shape, with a tapering screw pitch and thread diameter with a self-tapping thread. A bilayer bone finite element model representing the cortical and cancellous bone of the cervical spine pedicle was used for pullout strength test. According to our CT-based study of cervical pedicle anatomy in a normal population, the final CPS was created according to the parameters that yielded the best biomechanical strength according to finite element studies. The safety of CPS insertion, in terms of pedicle wall penetration, was assessed in 3D-printed cervical spine models of C3-C7. The pullout test was subsequently performed in a tri-layer sawbones foam model to compare the novel CPS, convention CPS, and lateral mass screw.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The final screw design was a taper configuration with core diameter from 2.5 to 2.0 mm, thread diameter from 4.0 to 2.5\u2009mm and pitch length from 1.0 to 1.25\u2009mm. A total of 60 screws (30 conventional CPS screw and 30 Novel CPS screw) were tested in 6 3D cervical spine models. No case of pedicle wall perforation were found in the novel-design CPS group. In the conventional CPS group, 8 pedicle wall perforations were encountered, which was a statistically significant difference (p\u2009=\u20090.002). The novel CPS screw design and conventional CPS screw yielded pullout strengths of 449.7\u2009N and 495.0\u2009N, respectively, which showed no statistical difference. The LMS screw yielded a pullout strength of 168.3\u2009N, showing statistically less strength compared with the 2 types of CPS screws.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The proposed novel CPS could decrease pedicle wall perforation and enhance the safety of screw insertion. Its pullout strength is comparable to that of a 3.5-mm standard CPS and superior to that of a 3.5-mm lateral mass screw.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0331066","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T17:31:31Z","timestamp":1756402291000},"page":"e0331066","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Novel cervical pedicle screw design to enhance the safety insertion without compromising biomechanical strength"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1941-2051","authenticated-orcid":true,"given":"Pilan","family":"Jaipanya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7496-2670","authenticated-orcid":true,"given":"Pongsthorn","family":"Chanplakorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annop","family":"Sikongkaew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anak","family":"Khantachawan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suphaneewan","family":"Jaovisidha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-8789","authenticated-orcid":true,"given":"Thamrong","family":"Lertudomphonwanit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"issue":"8","key":"pone.0331066.ref001","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1097\/00007632-200004150-00011","article-title":"Complications of pedicle screw fixation in reconstructive surgery of the cervical spine","volume":"25","author":"K Abumi","year":"2000","journal-title":"Spine"},{"issue":"7","key":"pone.0331066.ref002","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/BSD.0b013e318031af8b","article-title":"Biomechanical comparison of unicortical versus bicortical C1 lateral mass screw fixation","volume":"20","author":"JC Eck","year":"2007","journal-title":"J Spinal Disord Tech"},{"issue":"22","key":"pone.0331066.ref003","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1097\/00007632-199411001-00007","article-title":"Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine","volume":"19","author":"Y Kotani","year":"1994","journal-title":"Spine (Phila Pa 1976)"},{"issue":"22","key":"pone.0331066.ref004","doi-asserted-by":"crossref","first-page":"2899","DOI":"10.1097\/00007632-200011150-00011","article-title":"Surgical treatment of cervical destructive spondyloarthropathy (DSA)","volume":"25","author":"K Abumi","year":"2000","journal-title":"Spine"},{"issue":"9","key":"pone.0331066.ref005","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1007\/s00586-009-1032-7","article-title":"Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope","volume":"18","author":"Y Yukawa","year":"2009","journal-title":"Eur Spine J"},{"key":"pone.0331066.ref006","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/1471-2474-15-125","article-title":"Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation","volume":"15","author":"P Chanplakorn","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"issue":"8","key":"pone.0331066.ref007","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.clinbiomech.2009.05.002","article-title":"Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping","volume":"24","author":"L-H Chen","year":"2009","journal-title":"Clin Biomech (Bristol)"},{"issue":"10","key":"pone.0331066.ref008","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/01.brs.0000261566.38422.40","article-title":"Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength","volume":"32","author":"DJ Burval","year":"2007","journal-title":"Spine (Phila Pa 1976)"},{"issue":"24","key":"pone.0331066.ref009","doi-asserted-by":"crossref","first-page":"2800","DOI":"10.1097\/01.brs.0000192297.07709.5d","article-title":"The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae","volume":"30","author":"M Neo","year":"2005","journal-title":"Spine"},{"issue":"5","key":"pone.0331066.ref010","doi-asserted-by":"crossref","first-page":"472","DOI":"10.3171\/2011.6.SPINE10809","article-title":"Intraoperative, full-rotation, three-dimensional image (O-arm)-based navigation system for cervical pedicle screw insertion","volume":"15","author":"Y Ishikawa","year":"2011","journal-title":"J Neurosurg Spine"},{"key":"pone.0331066.ref011","doi-asserted-by":"crossref","DOI":"10.1016\/j.wneu.2020.03.171","article-title":"Cervical pedicle screw insertion using O-arm-based 3D navigation: technical advancement to improve accuracy of screws","volume":"139","author":"K Wada","year":"2020","journal-title":"World Neurosurg"},{"issue":"1","key":"pone.0331066.ref012","doi-asserted-by":"crossref","first-page":"96","DOI":"10.21037\/jss-24-45","article-title":"A new minimally invasive cervical pedicle screw (CPS) fixation system using intra-operative computed tomography-guided navigation","volume":"11","author":"C Blume","year":"2025","journal-title":"J Spine Surg"},{"issue":"4","key":"pone.0331066.ref013","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1007\/s00586-025-08679-2","article-title":"Cervical pedicle screw placement with patient-specific 3D-printed guides: accuracy and safety in a clinical experience","volume":"34","author":"N Marengo","year":"2025","journal-title":"Eur Spine J"},{"issue":"6","key":"pone.0331066.ref014","doi-asserted-by":"crossref","DOI":"10.3171\/2024.9.FOCUS24431","article-title":"Accuracy of cervical pedicle screw placement with a robotic guidance system via the open midline approach","volume":"57","author":"Y Yamamoto","year":"2024","journal-title":"Neurosurg Focus"},{"issue":"12","key":"pone.0331066.ref015","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1016\/j.spinee.2024.08.012","article-title":"Pedicle screw placement in the cervical vertebrae using augmented reality-head mounted displays: a cadaveric proof-of-concept study","volume":"24","author":"MA Ruiz-Cardozo","year":"2024","journal-title":"Spine J"},{"key":"pone.0331066.ref016","article-title":"Benefits and Pitfalls of O-Arm Navigation in Cervical Pedicle Screw","volume":"159","author":"HK Shin","year":"2022","journal-title":"World Neurosurg"},{"key":"pone.0331066.ref017","article-title":"Accuracy and safety assessment of subaxial cervical pedicle screw instrumentation: a systematic review","author":"Y Irmak","year":"2025","journal-title":"Spine J"},{"issue":"20","key":"pone.0331066.ref018","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1097\/00007632-199610150-00003","article-title":"Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches","volume":"21","author":"RM Miller","year":"1996","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331066","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T17:31:36Z","timestamp":1756402296000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331066"}},"subtitle":[],"editor":[{"given":"KOICHIRO","family":"ONO","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":18,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331066","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,28]]}}}